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HHD 2024/5785 Registration
Annual YK Appeal 2024/5785
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New Congregant Form
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Congregant Information
Shalom and welcome to Congregation Shir Shalom of Westchester and Fairfield Counties.
We are delighted you have chosen to become part of our community.
Please enter all applicable information in this form for our records and to help us communicate with you.
Note: Your responses will be maintained by the Shir Shalom Office and used solely for administrative purposes. We do not disclose your information to third parties.
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First Name: Congregant A
Informal name if preferred:
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Last Name: Congregant A
Hebrew Name
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E-Mail Address: Congregant A
Cell Phone: Congregant A
Home Phone
Alternate Phone/Work
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Street Address
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City
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State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip
Mailing Address if different than Home address:
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Birthday: Congregant A:
Occupation
Employer
City/Town where you grew up:
Marital Status:
Choose from Dropdown
Married
Single
Domestic Partners
Widowed
Divorced
If Married, please tell us Wedding Date:
Religious Background
Choose from dropdown
Reform
Conservative
Orthodox
Other: see next question
If choose other, please specify religious background here:
Previous Synagogue Membership: If Yes, please list name(s) here:
Camps you attended:
College/Grad School Attended: (List schools here)
Are you a single adult family household? If yes, skip to Family Information Section
Yes
No
First Name: Congregant B
Informal name Congr. B, if preferred:
Last Name: Congregant B
Hebrew Name
E-Mail Address: Congregant B
Cell Phone: Congregant B
Alternate Phone #
Birthday: Congregant B:
Religious Background
Choose from dropdown
Reform
Conservative
Orthodox
Other: see Next question
If choose other, please specify religious background here:
City/Town where you grew up:
Cong. B: Previous Synagogue Membership: If Yes, please list name(s) here:
Cong. B: Camps you attended:
Cong. B: College/Grad School Attended: (List schools here)
Occupation
Employer
FAMILY INFORMATION
Children or Dependents In Household Under 26 Years of Age
First Child: First Name
First Child Last Name
Gender
Birth Date
Second Child: First Name
Second Child Last Name
Gender
Birth Date
Third Child: First Name
Third Child Last Name
Gender
Birth Date
Fourth Child: First Name
Fourth Child Last Name
Gender
Birth Date
Child/Children's Hebrew Names:
Adult Children Not Residing In Your Home
Names of Adult Children/Spouse
Names and ages of Grandchildren
Yahrzeit Observance
Please list the names of loved ones whose Yahrzeit you wish to have acknowledged during Shabbat worship services.
Please list the Name, Relationship to you and Date of Death. (Ex: Molly Rosen, mother of Sally, 1/1/2021)
If you do not have any Yahrzeit Observances, please skip below to Background Information section
Full Name
Relationship
Date of Death
Full Name
Relationship
Date of Death
Full Name
Relationship
Date of Death
Full Name
Relationship
Date of Death
Please list any additional Yahrzeit observances here: (Name, relationship, date of death)
Background Information
How did you hear about us?
(Ex: Family, friends, Website, social media, Print ad, live nearby, if referred by a congregant-please include name)
Why Have you Chosen to Affiliate with Shir Shalom: check all that apply
Connection to Jewish Community
Participate in adult learning and social programs
Holiday Observances
Shabbat Worship
Enroll Children in Early Childhood Center
Enroll Children in Religious School
Prepare for Bar/Bat Mitzvah
Support Jewish Presence in our community
Getting Involved
We are so happy that you have chosen to become part of OUR Shir Shalom community. Together we can do much. As a community we hope that you and your family will regularly attend services and participate in the many programs offered by Shir Shalom. We ask that you share your talents, interests and ideas with us and engage with our professional staff and lay leaders. A Shir Shalom congregant will call upon you to extend a personal welcome. We look forward to meeting you soon.
CONGREGANT A: Please answer questions below
Committee Opportunities
Education
Ritual
Social Action
Congregants Committee
Caring Committee
Finance
Special Arrangements
House/Facilities
Adult Programming
Communications
Learning Opportunities
Adult Education
Torah Study
Shabbat Services
Parenting
Social Opportunities
Sisterhood
Brotherhood
Youth Group
Tot Programs/Tot Shabbat
Talents/Interests
Graphic Design
Web Design
Marketing
Fundraising
Cooking
Instrumental Music
Singing
Knitting
Mah Jongg
Photography
Gardening
Book Club
Theater
Writing (articles or creative)
Language Skills: Do you read, speak and/or Chant Hebrew? Please indicate specifics
Language Skills: Do you speak any other languages? Please list here
CONGREGANT B: Please answer questions below
Committee Opportunities
Education
Ritual
Social Action
Congregants Committee
Caring Committee
Finance
Special Arrangements
House/Facilities
Adult Programming
Communications
Learning Opportunities
Adult Education
Torah Study
Shabbat Services
Parenting
Social Opportunities
Sisterhood
Brotherhood
Youth Group
Tot Programs/Tot Shabbat
Talents/Interests
Book Club
Cooking
Canasta
Fundraising
Graphic Design
Instrumental Music
Knitting
Mah-Jongg
Marketing
Photography
Gardening
Singing
Theater
Web Design
Writing (articles or creative)
Language Skills: Do you read, speak and/or Chant Hebrew? Please indicate specifics
Language Skills: Do you speak any other languages? Please list here
Do you give permission for your family's photographs to be shared in Temple Communications/Newsletters?
Yes
No
Do you give permission for your contact information to be included in our Temple Directory? This information can only be seen by other congregants and CSS employees and clergy.
Yes
No
Please use the space below for any questions/comments or to tell us anything else about your family that you think would be helpful:
Thank you for supporting Congregation Shir Shalom!
Wed, November 6 2024 5 Cheshvan 5785